Clinical Appeals Analyst
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Job Description
Analyze and research complex clinical appeals within Blue Cross NC. Ensure compliance with state and federal requirements while coordinating with various departments.
Responsibilities:
- Provide clinical consultation with non-clinical staff within the Appeals Department
- Coordinate all aspects of the appeals process to ensure compliance with medical necessity criteria and other requirements
- Analyze complex/non-routine member and provider appeals
- Present analysis and documentation to appropriate physician committee and BCBSNC leadership
- Provide written documentation of case determinations and handle complaints/grievances as defined by the federal government
Requirements:
- Registered Nurse in the state of North Carolina
- 3 years of clinical experience
- Licensed in the State of North Carolina
Benefits:
- Medical, dental, and vision coverage along with numerous health and wellness programs
- Parental leave and support plus adoption and surrogacy assistance
- Career development programs and tuition reimbursement for continued education
- 401k match including an annual company contribution
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